Why is it that smoking--so expensive, personally injurious, and detrimental to the public purse--is still an essential part of daily life for so many of us? The primary answer is craving: Smoking is more reinforcing than crack cocaine.

Teasing out the factors--psychological, neurological, and genetic--that contribute to nicotine dependence is a complex process, as we report on page 21. But the potential payoffs from new treatments in terms of health benefits (and developer profits) guarantees huge interest and promises rapid progress. In the meantime, the bigger bang per buck comes not from mechanistic biology and molecular therapies but from primary prevention programs.

A major boost to tobacco prevention in the United States is the State Tobacco Settlement, an extraordinary agreement signed in 1998 between tobacco companies and the states. The settlement's stand-out component is the payment amount: The companies will pay the states up to $250 billion (US) over 25...

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